Minggu, Desember 08, 2013

Know anesthesia or general anesthesia


Lately a lot of media and social networking to discuss the alleged medical malpractice incident . The last case is the case of the death bustling performed cesarean section patients in Manado . Cesarean section is the usual case by gynecologists , performed using general anesthesia or regional anesthesia or a combination of both , which is performed by the anesthetist . Actually, if the anesthesiologist 's role in an operation ? Perhaps the article below can explain or add insight in understanding anesthesia .
Anesthetic techniques can be divided into two major categories, namely general anesthesia or general anesthesia and regional anesthesia or anesthetic half body . General anesthesia that removes the awareness and pain that a patient does not feel the surgery . Regional anesthesia only make a certain body area becomes numb , and the patient remains conscious , for example in the abdominal area down operations . In certain circumstances , sometimes it takes a combination of general and regional anesthesia . In general anesthesia , muscle relaxants can be given , so patients need to receive artificial respiration of the anesthesiologist . An anesthesiologist is usually assisted by a nurse anesthetist assigned to assist the process of anesthesia until the operation is completed .
There are several techniques of general anesthesia whose election depends on the type of surgery , patient age , and condition of the patient . The general anesthetic technique election will be decided by the anesthetist and will be communicated to the patient . Techniques include anesthesia with general anesthesia drugs given through a vein or total intravenous anesthesia ( Tiva ) , and anesthesia using anesthetic gases that make the patient sleeping . Techniques that use gas anesthesia administered through a facemask manner (face mask ) , the laryngeal mask airway ( LMA ) , and intubation with an endotracheal tube or pipe laying ( ET ) is put up into the airways ( larynk ) .


Total intravenous anesthesia
Anesthetic technique is done by giving anesthetic drugs through the veins or intravenous . The drug is injected to make the patient fall asleep and do not feel pain during the surgery . The drug can be administered continuously using a pump syrinx , or discontinuous ( intermittent ) . How this is done in a surgical anesthetic that is relatively short , and do not need perfect relaxation of the muscles of the body, such as the content of curettage surgery , incision lipoma or fatty lumps , mounting casts , and others . Currently Tiva anesthesia can replace with gas anesthesia .

Anesthesia with gas
Anesthetic technique is done by giving anesthetic drugs through continuous gas inhaled anesthetic patients . As a result of inhalation of this gas , making the patient is unconscious and can do surgery . This technique is performed on patients who need to sleep in such a mounting plate operation on a broken collarbone , and pediatric patients . Gas anesthesia can be administered through a facemask and LMA . Surgery in patients with head and neck area , it can be given anesthesia using endotracheal pipe fitting ( ET ) , which require muscle relaxants , such as tonsillectomy , cutting the intestine , and the operating area of the chest cavity .

Selection of general anesthesia techniques whether using gas or Tiva , depends on the condition of the patient , and the availability of equipment . One of the disadvantages of using gas is air pollution , due to anesthetic gases can spread throughout the operating room , it can lead to all personnel in the operating room and participate inhaling anesthetic gas exposure and its long- term side effects that may be caused, such as liver damage . In some modern anesthesia machines , anesthesia gas machines will be sucked out of the engine and discharged into the atmosphere outside the operating room . In the end , no method is 100 percent safe anesthesia . All there is a risk that actions can occur , ranging from allergic itching , until respiratory arrest and cardiac arrest requiring resusisitasi or rescue action . Always communicate with the anesthetist who will perform anesthesia , so that all can understand the benefits and risks that may arise .

Minggu, November 10, 2013

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Selasa, November 05, 2013

Tantangan dokter masa depan

          Perkembangan dunia kedokteran di Indonesia saat ini makin pesat. Januari tahun 2014 mendatang akan diterapkan sistem baru pelayanan kesehatan. Sistem ini akan menjamin semua penduduk di Indonesia akan terlindungi kesehatannya melalui asuransi yang disebut era BPJS. Pada era ini, maka seorang penduduk yang sakit tidak perlu membayar biaya pengobatan kepada dokter keluarganya. Biaya premi diambil dari iuran tiap penduduk yang mempunyai penghasilan. Jika penduduk tersebut dikategorikan tidak berpenghasilan, maka premi akan dibayarkan oleh pemerintah. Sudah sekian tahun dunia kedokteran di Indonesia berubah sistem. Mulai dari sistem wajib kerja bagi lulusan dokter, yang mewajibkan setiap dokter yang batru lulus akan langsung diangkat menjadi PNS dan ditugaskan di tempat atau daerah tertentu di Indonesia, kemudian era PTT atau pegawai tidak tetap, yang mewajibkan dokter yang baru lulus harus mengabdi di tempat tertentu dengan gaji disesuaikan temapt pengabdiannya. Era sekarang adalah era BPJS yang mewajibkan seorang dokter yang baru lulus harus menjalani program internship selama setahun kemudian baru boleh praktek mandiri. Praktek mandiri pun harus memenuhi kriteria BPJS yaitu hanya dokter keluarga  yang nantinya dapat menangani pasien. Dokter harus bekerja di klinik pelayanan primer atau pratama sehingga dapat menerima kapitasi dari sejumlah penduduk di sekitar klinik. Untuk dapat bekerja di klinik pratama, maka dokter yang baru lulus harus mengikuti beberapa pelatihan tentang dokter layanan promer. Kelak semua dokter baru harus lanjut sekolah spesialis kedokteran primer atau klinik di rumah sakit. Apabila dokter tidak sekolah lagi, maka hanya dapat bergelar dokter tanpa boleh memegang pasien. Dokter hanya boleh bekerja di lapangan yang tidak bersentuhan langsung dengan pengobatan pasien, misalnya di pabrik obat, jadi direktur RS, atau peneliti, dll.
          Berdasarakan PERATURAN MENTERI PENDIDIKAN DAN KEBUDAYAAN REPUBLIK INDONESIA NOMOR 73 TAHUN 2013 TENTANG KERANGKA KUALIFIKASI NASIONAL INDONESIA BIDANG PENDIDIKAN TINGGI, maka dokter yang baru lulus menempati kelas kualifikasi jenjang 7 setara dengan lulusan pendidikan profesi, kemudian seorang spesialis setara dengan jenjang 8 atau magister, dan jenjang 9 setara dengan pendidikan doktor atau spesialis 2/konsultan. Apakah artinya? penetapan kualifikasi ini sangat penting terhadap pengakuan seorang dokter di dunia pendidikan. Bahwa sekarang, seorang dokter spesialis sudah dianggak sebagai magister atau S2, sedangkan program doktoral adalah setara dengan konsultan klinik. 
         Sampai saat ini sudah dihasilkan ribuan dokter dari kira-kira 73 institusi pendidikan dokter. Ada beberapa perguruan tinggi yang terlalu berani menrima mahasiswa baru tanpa melihat kemampuan internal universitas. Sehingga munculah dokter yang belum layak memberikan pengobatan atau belum lolos ujian persamaan seIndonesia (UKDI dan OSCE).   Penyelenggaraan ujian UK ini berlangsung serentak secara nasional baik fakultas negeri maupun swasta. Banyak fakultas kedokteran swasta yang bahkan melampaui fakultas kedokteran negeri. Dengan munculnya ujian bersama ini, maka dapat dilihat kualitas pembelajaran masing-masing fakultas kedokteran. Masihkah fakultas negeri dianggap yang terbaik? ataukah swasta masih dipandang sebelah mata?

Minggu, Juli 07, 2013

Kit Pertolongan Pertama Pada Kecelakaan (First aid kit)

Kecelakaan atau kegawatan dapat terjadi di sekitar anda. Anda harus siap seandainya kecelakaan itu terjadi di rumah. Selain anda sebagai penolong, maka perlu juga seseorang yang membantu mencarikan unit medis terdekat (misalnya yang memanggilkan rumah salit atau puskesmas terdekat). Persiapkan alat-alat berikut yang dapat anda masukkan ke kotak P3K, yaitu:


  1. Acetaminophen dan / atau
  2. Ibuprofen
  3. Pinset
  4. tisu alkohol
  5. pembersih tangan antiseptik
  6. pita perekat medis
  7. kasa steril (empat kotak inci adalah yang terbaik)
  8. perban elastis
  9. beberapa ukuran perban perekat
  10. penyeka gigitan serangga
  11. salep antibiotik
  12. gunting perban
  13. perban segitiga
  14. kemasan dingin instan
  15. sarung tangan karet


Jumat, Juni 28, 2013

Circumcision with local anesthesia or general anesthesia?


          Circumcision is obligatory for a Muslim after puberty. Circumcision is done by cutting some skin in the pubic end . Sometimes circumcision performed on children, or even a new born baby, for certain medical reasons, such as the presence of phimosis or adhesions in a hole out in pubic. Phimosis causing obstructed flow of urine into the urethra causing inflammation. It is necessary to process anesthesia, either with local or general anesthesia, So that the patient does not feel pain during the action.
          In the pediatric patients, patients with special needs such as the existence of hemophilia, mental weakness patients, or patients with excessive fear, then circumcision, a general anesthetic is a better choice than a local anesthetic. Circumcision with special needs or complications are usually handled by a surgeon. After the action was decided by the surgeon and the patient's family agreed, then the surgeon will consult to the anesthesiologist for anesthesia methods. Subsequently, the patient or his family will be explained about the method of general anesthesia to be performed on the patient.
          General anesthesia is an anesthetic or anesthetic technique that makes the patient is unconscious or asleep deep enough so that surgery can be performed safely and comfortably. On the use of this technique, patients who had planned the operation time will be required for laboratory mainly routine blood check and asked to stop eating and drinking since at least 6 hours before surgery. This treatment is referred to as preoperative preparation. Blood tests intended that if there are certain diseases such as bleeding disorders, anemia or infection, may soon be known. Fasting before surgery intended to make the stomach empty. Empty stomach is necessary so that the risk of vomiting or regurgitation in patients anesthesia process can be minimized. Vomiting or regurgitation that occurs can lead to aspiration, namely the inclusion of acidic gastric contents into the airways or lungs. Preoperative preparation is basically aimed at making conditions optimal for patient anesthesia and surgery.
          If the patient is cooperative or be invited to cooperate with the surgeon, for example, can calmly undergo circumcision, it can be done local anesthesia. Local anesthetic procedure is simpler than general anesthesia. At the local anesthetic technique, patients do not need to fast beforehand. Sufficient local anesthesia by injecting anesthetic into the pudendal nerve or nerves around the area that will be done surgically. In contrast to general anesthesia requires patient monitoring after surgery, until the patient is fully conscious, the patient with local anesthesia can go home if the surgery has been completed.
        Based on the above description, it is the patient that there is no contraindication to general anesthesia, can choose circumcision under general anesthesia. This is of course with consideration of surgeons and anesthesiologists.